Angelo Volandes, MD, a physician at Massachusetts General Hospital, wrote an opinion piece published in the Boston Globe today. He tells the story of a patient dying of cancer, with whom he brought up the topic of end-of-life care options:

“For the next hour I introduced a vocabulary as foreign to her as spondee and trochee were to me. Life-prolonging treatment and CPR, ventilators and intubation, DNR and DNI — terms that she would need to learn quickly. Unfortunately, I was trying to teach her a new lexicon in the midst of the haze of nausea and hospitalization.

Dazed and confused, they looked at me blankly. Words often fail us in medicine. How could I explain these abstract ideas and treatments? Most patients think hospitals and medical interventions look like what they see on television where most survive CPR beautifully; the truth is most people with advanced incurable cancer do not do well with these interventions and often suffer at the end of life.

Finally, I tried a different approach. “Do you mind if we take a walk through the ICU?” I said.

If words failed me, perhaps seeing the intensive care unit would help. Seated in a wheelchair …Helen got a tour of the ICU, where she saw an intubated patient on a ventilator and a patient having a large intravenous line placed. Her decision-making would be informed by what she saw, instead of having to imagine what my terms really meant.

When we arrived back at her room, she looked at me and said, “Words, words, words. . . Angelo, I understood every word that you said — CPR and breathing machines, but I had no idea that is what you meant.”

I was reprimanded by the ICU staff for bringing Helen and her husband on that tour, but I was quickly forgiven. Evidently, many felt, like me, that patients deserve to be educated in order to make informed decisions about end-of-life choices.”

That was years ago when he was a medical resident.

Today, he goes on to explain, he and others use video decision aids to help people think about care options.

Comments

Carol Countryman posted on June 18, 2012 at 6:39 pm

Our youngest sibling just celebrated his 65th birthday. The other three of us are 79, 70 and 67. Two of us have had serious health issues (that at the moment are dormant) and two of us have been largely unscathed. A fifth sibling died of Lewy body syndrome two months ago, two weeks before her 80th birthday.

We are intelligent, educated, strong people. But we are not knowledgeable about end-of-life issues (although our sister’s situation gave us some insight) and the information in the Globe article is so very helpful. It goes hand in hand with a New York Times article I read recently that said most elderly people have an idealized vision of their final days, believing that they will spend a few days in bed and then die. The reality, so the article pointed out, is much more grim.

We live between Rochester and Syracuse, NY, and I hope that the hospitals there have subscribed to the idea of the video. We all know that we are going to die and we all, I’m sure, want that to be, as much as possible, in the manner we would wish.

Thank you for this important information.

Carol Countryman

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